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Job Description
To evaluate and monitor the utilization of medical services, procedures, tests, medications,referrals, and cost-effectiveness. Apply clinical expertise and analytical skills to uncover innovative strategies that more effectively address the needs of specific populations, enhancing outcomes, stakeholder contentment, and departmental productivity.
Clinical Benchmarking and Best Practices Analytics
- Oversee the collection and integration of clinical data from diverse sources, including electronic health records, patient outcomes, and operational metrics.
- Collaborate with IT teams to ensure data integrity and completeness.
- Utilize descriptive analytics to identify patterns, trends, and areas for improvement in clinical practices.
- Implement predictive analytics models to forecast clinical trends and recommend proactive interventions.
- Apply prescriptive analytics to recommend actionable strategies for enhancing clinical operations
Internal Utilization Management &Telemedicine Efficiency
- Implement measures to assess the outcomes of telemedicine visits, including patient outcomes, referral pattetn, prescritptions and follow-up care.
- Benchmark against peer groups that effectively measure and improve telemedicine outcomes.
- Monitor and establish a feedback loop for the medical team, encouraging open communication and continuous improvement.
- Ensures timely escalation of unresolved care coordination issues to the appropriate level.
- Proactively communicates with physicians to discuss opportunities identified related prescription rates, referrals, admissions and continued stay.
Partner Provider Collaboration
- Collaborate with partner providers in the utilization review process, ensuring that medical services are aligned with best practices and utilization guidelines.
- Establish a feedback loop for continuous improvement based on utilization review outcomes.
- Leverage behavioral analytics and data-driven insights to understand the patterns and trends in the behavior of partner providers.
- Identify opportunities for positive provider opportunities and interventions where necessary.
- Regularly analyze the performance of partner providers, considering key metrics such as patient outcomes, efficiency, and adherence to utilization guidelines.
Cost-effectiveness Analytics
- review processes, ensuring the efficient allocation of resources and identifying opportunities for cost savings without compromising quality.
- Participate in validating care pathways from commercial point of view and provide feedback to the medical team
- Work with key internal stakeholders, mainly the medical operation teams to collaborate on executing different projects.
Skills
- Data visualization tools and Analytical skills.
- Problem-solving Skills.
- Communication and presentation skills.
Education
Bachelor's/Master's degree medical, healthcare management or healthcare informatics
Job Details
Preferred Candidate
Bupa Arabia
Bupa Arabia is a healthcare insurance company based in the Kingdom of Saudi Arabia. We are an associate business of Bupa Group, which is a global healthcare company with an international reach that extends across multiple business operations, practices, and resources.
Founded in October 1997, Bupa Arabia was initially established through a partnership between Bupa Global International and Nazer Group, with the key focus to provide health insurance services with high quality and competitive prices, while ensuring a distinctive experience for customers. Bupa Arabia has since evolved into a fully Saudi-owned and operated company. Our transformation from a joint venture into a publicly traded company on the Saudi Stock Exchange occurred in 2008, as we made 40% of our shares available to the public during our Initial Public Offering (IPO).
As a subsidiary of the global Bupa Group, we draw upon international expertise while maintaining a profound understanding of local healthcare requirements and regulations. This allows us to offer comprehensive healthcare insurance solutions tailored to the unique needs of the Saudi Arabian market.
Bupa Arabia prides itself on its commitment to the wellbeing and development of its employees, providing them with the same standard of care, support, and professionalism that it expects to be delivered to its customers.
Our core values shape every aspect of our work and culture:
Commit – Own it with accountability and urgency.
Collaborate – Win together through cross-functional synergy.
Care – Put people first, both employees and customers.
